Posts Tagged ‘simulation’

Yeah, forgot to mention something about Simulation Day.  After our group went first, we had a lot of time to sit back, observe the other students, and just enjoy the day.  About 2/3 of the way through the simulations, I heard my name being called from near the front of the room.  It was the Director of the Simulation Labs and the Director of Clinical Rotations, and they were pointing at me, asking me to come with them.

“Uh oh,” I thought.  “I must be in trouble.”

Alas, I was not in trouble.  They simply wanted to use me for my freakish limbs.  That’s right, I was, once again, The Guy With the Long Arms.

As part of the simulation, they needed to pretend I had to get into the chair from my bed, and 3 students were in charge of moving me.  I was instructed, “Act as weak as humanly possible.  You just came out of surgery, and you have absolutely zero strength.”

Awesome.  I can do that!

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Prepare ye for stream of consciousness.  The following will make no real sense whatsoever.

So, the last week.  What’s happened?  Lots.  Last Wednesday I was the “team leader” for clinical, meaning I helped delegate the patients the other students would see, and decided when people would eat dinner, and generally stood around asking if anyone needed help … and that’s pretty much it.

Then on Thursday was our very last clinical day of the semester.  Med/Surg I was coming to an end.  My patient was an elderly woman who was in the hospital for a revision of her ileostomy.  Also, she wasn’t all that with it.  AAO x1 or x2, maybe.  (Awake, Alert, and Oriented to Person, Place, and Time — so she was certainly awake and alert, but oriented only to Person and sometimes Place.  She didn’t seem to have any mastery of time.)

My favorite line from this elderly woman, when the occupational therapist was in her room, asking her questions:  “You just shut up or I’ll sock you in the face.”

She was perfectly fine most of the day; however, I did have to empty her ileostomy bag, because it had ballooned up with some gas, and when I did … well, let’s just say I think I was having some flashbacks, because I could feel the saliva coming up into my mouth and was about to throw up.  (For those of you who don’t know, I once had an ileostomy for about 3 months.)  My stomach’s been super strong all semester long, and a simple bag change makes it turn somersaults.  Oh well, goodbye, chance of becoming a Wound, Ostomy, Continence Nurse.

After clinical, around 6PM, we all went out to a local restaurant, where a ton of other students started pouring in.  Was good to just let loose a bit and celebrate the end of clinical for the semester.  This party moved on to the local student hangout, where I finally left around 12:30AM.  I felt old — can’t keep up with these young whippersnappers.

Friday night was The 7th Annual Mustache Bash.  That’s right.  A party celebrating the allure of the lip sweater.  I had grown out my beard for about a month, so it was fun shaving it into a giant handlebar with super-large mutton chops.  Again, stayed out too late and got to bed around 3:15AM.

Monday and Tuesday class — the last classes, thank goodness.  Monday night completed my online final exam in Epidemiology.  Wanted to do it Sunday night, but got back from dinner a bit too late, and wanted to get to bed earlier.  Got an 89.5% on the Epi final, which wasn’t too bad, I suppose — left me with an A- for the course, I believe.  It consisted of 60 multiple-choice and true/false questions.  And that took me about 2 hours and 40 minutes.  A sample question:

The President invites a dozen or so of his dearest friends, prominent rival legislators, to a formal luncheon.  The salmon mousse is even more popular than highlights from the health care reform movement.  Within 24 hours, 11 of the 17 diners experience abdominal pain, vomiting, and diarrhea.  The President, who happens not to like salmon because it deadens the taste buds to the subtleties of beef jerky, feels fine.  In fact, he goes jogging.  Of the 11 guests with symptoms, 4 have fever and 7 do not; 5 have an elevated white blood cell count and 6 do not; 6 ate shrimp bisque and 5 did not; 9 ate salmon mousse and 2 did not; and one goes on to have surgery for acute cholecystitis due to an impacted calculus in the common bile duct.  All of the cases recover within 3 days, with the exception of the senator who underwent surgery; she recovered over a longer period of time.  The people at this luncheon had shared no other meals at any time recently.  An early priority in investigating this outbreak would be to:

A. perform stool tests
B. submit food samples to the laboratory
C. temporarily close the kitchen
D. define a case
E. perform a case control study

The correct answer was D, by the way.  (I picked B.)

Last night was able to go out again and celebrate another local university’s nursing program’s last day of finals.  My friend Will (you can see his blog here) and his friends were celebrating, so got to meet some cool people from another program.

Today we had our first Simulation Day.  We all met up in the simulation labs, where we were put through a patient case.  We were divided up into groups of about 6, and sent into a room with a “patient.”  We were told a bit of information and were then prodded to just “go ahead and do what you would normally do.”

It felt a bit more like an ER to me than a patient’s room, so we were all a bit flustered, having been on the floor for only several weeks.  In any event, the patient presented with fever of 102, chills, nausea and vomiting, and severe abdominal pain.  The “patient” actually talked to us, in the form of some guy standing behind a one-way mirror.  The mannequin playing the patient was a Sim-Man, so he was actually breathing and had real bowel sounds, etc.

Since we were instructed beforehand to brush up on our disease states, specifically hypertension, diabetes, and appendicitis, I pretty much figured out from that + his symptoms that he must be suffering from acute appendicitis.  However, my “role” was to document his pain relief after a 2-mg IM injection of morphine, so I kind of stayed back and watched the other students perform their roles.  No one was really suggesting that his symptoms were indicative of appendicitis (and to further throw us off, one of the clinical instructors had his sister playing the role of “patient’s wife” and she was asking us a million questions).  I saw one of the students gently press on his upper abdomen, about 3 inches above his umbilicus, but that’s it.  I figured, I might as well do something here, even though it’s not my role.  The patient’s BP was climbing steadily, and the morphine was taking a long time (in my head) to come; the patient was complaining of severe pain.  So I went, washed my hands, put on some gloves, and moved in, saying, “Mr. Sun, I’m going to take a quick look and feel of your abdomen, ok?  Tell me when it hurts the most.”  Then I gently palpated his abdomen, starting with the left lower quadrant, then below the belly button, then above the belly button … and then finally moved to his right lower quadrant.  I remembered vaguely from some questions that you always palpate that area last in cases of suspected appendicitis.

When I got to his right lower quadrant, the patient yelped a bit when I pressed down … and then screamed bloody murder when I released the slight pressure.  Hmm, a pretty clear rebound tenderness, which we were also taught is a classic sign of that appendicitis.  Then suddenly, just as soon as were in there, we were told our round was over, and return for debriefing.

In our debriefing, one of the instructors said that I probably shouldn’t have palpated the patient’s abdomen a second time, since the other student had already done it, because I could have easily ruptured his appendix.  Here is what I said in my inner monologue:  “Whaaaa?  You mean that little press the other student gave on his upper epigastric region counted as palpating over his appendix for rebound tenderness?”  Here is what I said out loud in the room:  “Ok, that makes sense.”

Whatever.  You pick your battles.  And I didn’t want to call out my fellow student in front of an instructor.  It was supposed to be a fun exercise anyway.  Maybe she did palpate the entire abdomen and I just missed it — who knows?  Point is, it was chaos chaos chaos.

Eleven different groups went into that room and had their own little scenarios.  Turns out our patient did indeed have acute appendicitis and a ruptured diverticulum.  He went to the OR and returned with a bleeder.  I felt bad for some groups — one group went into the room and the patient was screaming about pain and was bleeding out of his incision site; another group went into the room and found the patient on the floor after transport left him to get into bed by himself after some testing.  And then some groups had easy tasks like checking his vital signs in the PACU.  All in all, a pretty fun day.

And did I mention that, while one group was in the room, the rest of us were watching them via closed-circuit TV?  So fun to be observed making mistakes by 60 of your peers.  Best line of the day goes to one male student:

STUDENT:  “Ok, Mr. Sun, we’re gonna put in your catheter now.”

PATIENT:  “Catheter?  What is that and where are you putting it in?”

STUDENT:  “Umm, it goes up your Johnson.”

Seriously!?!  Johnson?  Ok, that’s a semi-hilarious, and not-nearly-close-to-okay, thing to say to your patient.  We all had a good laugh.  One of the instructors felt compelled to come back and say to our group, “Umm, in the hospital, in the real world … none of us have ‘Johnsons,’ okay?”

A bunch of meetings tomorrow, then studying for finals commences.  Three finals on Tuesday (another set of integrated exams, which are, thankfully, not cumulative).  I’ll keep y’all posted on how things are going, because I’m sure you’re dyin’ to know.

So let’s see, the schedule for the upcoming days:

FRIDAY:  Sleep in, meeting, study, meeting, dinner, study, maybe some live music if I’m feeling ambitious.

SATURDAY:  Sleep in, study, groceries, study.

SUNDAY:  Church?, study, Sunday Night Movie Night with J.

MONDAY:  Sleep in, study.

TUESDAY:  3 finals, out with classmates to celebrate!

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Instead of going into the hospital for normal clinical today, we all met up in the simulation labs and learned all about IV therapy — peripheral IV lines, central lines, PICC, Hickman, Infusa-Port … the list goes on and on.  I don’t think we’re allowed to even start an IV until we graduate, so they just sort of “showed” us how to start one.  I don’t see why we couldn’t practice on the mannequin arms, but oh well.  By the way, our mannequin’s arm was at least 15 feet long.  Ok, that might be an exaggeration.  It was more like 5.

Wasn’t a very exciting day, more like … overwhelming a bit.  “This dressing is good for 3 days … this cap has to be changed out every 4 days … this tubing should be changed every 72 hours … these are good for only 24 hours … remember it’s important to check these every shift.”  I suppose one day it’ll just be second nature, but for now, I’m feeling a bit slammed with information.

Had a full house yesterday for S.A.N.L.O.P., which was nice.  It was C’s birthday, so was good to see him.  W bought him his brunch, and then we went to Flying Monkey Deuce and I bought him a cupcake.  Big spenders.  Was great to have the full gang there (minus E2 and K2, unfortunately) — K was there, S, C, W, all there.  Good times.  Some day we’ll get everyone there.  Last night called up M and we rode our bikes along the river out to the East Falls bridge and back down the other side — was a beautiful bike ride, and M and I got to talk some good stuff about nursing.  And then we all met up for C’s birthday at Monk’s for some frites and stuff.  Mmm, Monk’s.

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